Making waves: Wastewater-based epidemiology for COVID-19 – approaches and challenges for surveillance and prediction

TLDR

SARS‑CoV‑2 is shed in feces and wastewater, offering a community‑scale surveillance alternative that can detect infections—including asymptomatic cases—beyond the limited reach of clinical testing. This review consolidates current knowledge and identifies key factors for deploying wastewater‑based epidemiology to monitor COVID‑19.

Abstract

The presence of SARS-CoV-2 in the feces of infected patients and wastewater has drawn attention, not only to the possibility of fecal-oral transmission but also to the use of wastewater as an epidemiological tool. The COVID-19 pandemic has highlighted problems in evaluating the epidemiological scope of the disease using classical surveillance approaches, due to a lack of diagnostic capacity, and their application to only a small proportion of the population. As in previous pandemics, statistics, particularly the proportion of the population infected, are believed to be widely underestimated. Furthermore, analysis of only clinical samples cannot predict outbreaks in a timely manner or easily capture asymptomatic carriers. Threfore, community-scale surveillance, including wastewater-based epidemiology, can bridge the broader community and the clinic, becoming a valuable indirect epidemiological prediction tool for SARS-CoV-2 and other pandemic viruses. This article summarizes current knowledge and discusses the critical factors for implementing wastewater-based epidemiology of COVID-19.